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If you’ve ever experienced a crimson blood spot on the white part of your eye, you know very well how scary this bleeding looks and the worrying associations it creates with serious problems (eg a stroke).

This bleeding is not superficial. It occurs under the conjunctiva – the clear membrane that covers the white part of the eye and the inside of the eyelids. Its scientific name is subconjunctival hemorrhage (or hyposphagma).

But where does it come from and how serious is it? As the ophthalmologist surgeon Dr. Anastasios-I. Kanellopoulos, professor of Ophthalmology at New York University, is due to the rupture of a small blood vessel.

“The conjunctiva contains many capillary (very fine, hair-like) blood vessels. When one of them breaks, subconjunctival hemorrhage develops,” he says. “With it, the blood gets trapped under the conjunctiva and the patient cannot wipe it away. But because it does not affect the cornea or the inside of the eye, it does not create a vision problem.”

Although the condition looks very alarming, it is usually benign and goes away without treatment in about two weeks. However, it can sometimes be a manifestation of a serious underlying problem, especially when it is persistent or recurring. For this reason, patients should not neglect it but should consult their ophthalmologist.

Dr. Kanellopoulos answers the most common questions about subconjunctival bleeding, its causes and risk factors:


– Where is it usually due to?

It can be traumatic or automatic. Some activities and medical conditions increase the blood pressure in the veins, which can lead to a rupture of a capillary. These situations include:

Coughing loudly
Sneezing Vomiting
Lifting a heavy object
Bending over
Rubbing the eye forcefully
Taking certain medications (e.g. anticoagulants)
Head or eye injury
An eye infection
Wearing contact lenses

Less common causes of conjunctival bleeding are:

Diabetes mellitus
Disorders in blood coagulation
Sometimes, however, no cause is found for the rupture of the capillary vessel. In this case it is called idiopathic (ie of unknown etiology).


How common is it and who manifests it more often?

Subconjunctival hemorrhage is one of the most common reasons for visiting the ophthalmologist. It can occur in people of all ages and sexes, but is most often seen in young men who perform heavy manual work or engage in demanding physical activities.


What are the risk factors for its development?

The age. The frequency of spontaneous subconjunctival hemorrhage increases with age, especially after 50 years. This is due to the increased likelihood of comorbidities, such as hypertension, hyperlipidemia, and diabetes mellitus. One study also found an increased incidence in children during the summer holidays.

The use of contact lenses. Their users have an increased susceptibility to conjunctival diseases that cause dryness and friction and can lead to inflammation and rupture of capillaries.

Eye operations. Those who have had surgery (eg for cataracts) are at increased risk, especially when taking anticoagulant drugs.

Could he be hiding something serious?

In rare cases it may be a sign of a serious underlying problem, such as:

Vascular disease
Bleeding or clotting disorder
Severe asthma
Severe eye trauma

What symptoms does it cause?

Usually the only symptom is a bright red color in the white of the eye. But some patients also develop a very mild irritation of the eye.


How is subconjunctival bleeding treated?

Most sufferers do not need treatment. The blood will absorb itself over a few weeks. It will first turn from red-brown, then yellow and gradually disappear.

There are no treatments that speed up this process. The eye doctor may simply recommend warm pads (compresses) and artificial tears to reduce the redness a bit. However, if the cause is underlying problems (eg with your pressure), these should be addressed to prevent it from happening again.

What is the prognosis?

The prognosis is very good, because this disorder does not affect vision. However, there is a fairly high rate of recurrence. When there are no clear risk factors this percentage is around 10%. But it is higher in patients taking anticoagulant or antiplatelet drugs.

Are there ways to prevent it?

Usually spontaneous subconjunctival bleeding cannot be prevented unless you rub your eyes hard (the hard friction can break a capillary). But when the bleeding is related to underlying problems and disorders, treating them can prevent it.

When should a sufferer contact the doctor?

It is always a good idea to have subconjunctival bleeding evaluated by an ophthalmologist. A new assessment may also be needed:

If it does not go away in 2-3 weeks or

If your eye suddenly starts to hurt or swell or your vision decreases

If you have a history of eye injury or recurrent bleeding you still need an evaluation – possibly not only by the eye doctor, but also by your family doctor to check other problems such as your blood pressure.

  • illustration Credits By iStock

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